Ask A Doctor: Treating thumb arthritis

Question: I have been having pain at the base of my thumb near the wrist, and am having increased difficulty opening jars and turning doorknobs. Is there such a thing as thumb arthritis?

Answer: Thumb arthritis is a very common problem. It affects up to 10 percent of middle-aged women. In people older than 75, it affects 40 percent of women and 25 percent of men.

Thumb arthritis is the No. 1 cause of arthritis surgery in the upper extremity. Often, patients have arthritis in many parts of the body, including the hip and knee joints. In the thumb, the pain is located where the thumb attaches to the wrist (at what is called the carpometacarpal joint). The normal cartilage surfaces get worn away and bone starts rubbing on bone causing pain. Over time, daily activities become increasingly uncomfortable. Pain occurs with pinching and twisting motions, such as opening a jar, turning a doorknob, and even writing or brushing teeth. Lifting objects is often difficult as a result of the pain.

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The diagnosis of thumb arthritis is made with a history and physical exam as well as plain X-rays. Expensive tests are rarely, if ever, needed. The arthritis can range from mild to very severe. X-ray findings do not always correlate with the amount of pain.

Often, the pain of arthritis is very debilitating as a result of having to use our thumbs for a lot of activities.

The good news is that treatment is very effective. Treatment of thumb arthritis often starts with non-operative measures. Splints, anti-inflammatory medications and cortisone injections can be helpful. The goal of a splint is to limit the bone-on-bone motion that causes pain in the joint. Anti-inflammatory medications and cortisone injections aim to control the pain of arthritis.

When these treatments are no longer working or the pain is severe, surgery is very helpful. Surgery involves removing a small bone in the wrist where the bones are rubbing and causing pain. A tendon is used to suspend the thumb and prevent further bone-on-bone pain. After surgery, the thumb is immobilized for a short time, and then therapy is started to regain motion and strength of the thumb. My patients are extremely happy after this procedure. Their pain is gone and the thumb still moves and functions like normal. This is the most gratifying procedure I perform because patients have tremendous pain relief.

David Mikolyzk, M.D., is a fellowship-trained hand and wrist surgeon at Holy Family Memorial’s Lakeshore Orthopaedics.